WGU D052 (NAVIGATING CARE ACROSS THE
CONTINUUM) PRACTICE EXAM QUESTIONS WITH
CORRECT ANSWERS GRADED A+
When considering the regulatory requirements for healthcare, which agencies
primarily oversee the use of medication?
FDA and DEA
Medicare and Medicaid focus on specific groups of people. Individuals over the
age of 65 and disabled individuals are the current focus of what?
Medicare
Medicare =
Federal coverage for people over 65, certain people under 65 with disabilities
and people of any age with end stage renal disease
Medicaid =
Cooperative federal and state healthcare coverage for low-income adults,
pregnant women, and children
Page 1 of 86
,Medicare part
Part A
Part B
Part C
Part D
Part A-Hospital Insurance
Part B-Medical Insurance
Part C- Medicare Advantage (HMO includes A&B)
Part D- Prescription Drug
Qualified Medicare Beneficiary (QMB) Program:
Helps pay premiums, deductibles, coinsurance, and copayments for Part A, Part
B, or both programs
Specified Low-Income Medicare Beneficiary (SLMB) Program:
Helps pay Part B premiums
Qualifying Individual (QI) Program:
Page 2 of 86
,Helps pay Part B premiums
Qualified Disabled Working Individual (QDWI) Program:
Pays the Part A premium for certain disabled and working beneficiaries who
have disabilities
Medicare Part A helps cover what
Inpatient hospital care ● Skilled nursing facility care ● Hospice care ● Home
health care
Medicare Part B helps cover what
Services from doctors and other health care providers ● Outpatient care ● Home
health care ● Durable medical equipment ● Many preventive services
Medicare Part C covers what
includes all benefits and services covered under Part A and Part B and may
include extra benefits and services for an extra cost.
Page 3 of 86
, Medicare part D covers
helps cover the cost of Prescription drugs
Name other types of healthcare coverage
Private insurance coverage (such as group health plan or retiree coverage) ●
TRICARE ● COBRA ● Workers' Compensation ● Liability insurance coverage
Bundled payments
Bundle payments or episode payment models (EPMs) are an alternative means
of payment that encourage organizations to coordinate services to improve the
efficiency of care. Bundled payments are negotiated by CMS and third-party
payors to identify the total allowable expenditures (target price) for a specific
group of services. These payments are predetermined and agreed upon by the
payor and payee. If Medicare and Medicaid billing is acceptable to the
organization, then bundled payment services are already established.
Value based services
Value-based services assist in keeping the cost down. Organizations work to
provide services without exceeding the established cost. If possible, the
organization will attempt to increase its payment by providing less expensive
Page 4 of 86
CONTINUUM) PRACTICE EXAM QUESTIONS WITH
CORRECT ANSWERS GRADED A+
When considering the regulatory requirements for healthcare, which agencies
primarily oversee the use of medication?
FDA and DEA
Medicare and Medicaid focus on specific groups of people. Individuals over the
age of 65 and disabled individuals are the current focus of what?
Medicare
Medicare =
Federal coverage for people over 65, certain people under 65 with disabilities
and people of any age with end stage renal disease
Medicaid =
Cooperative federal and state healthcare coverage for low-income adults,
pregnant women, and children
Page 1 of 86
,Medicare part
Part A
Part B
Part C
Part D
Part A-Hospital Insurance
Part B-Medical Insurance
Part C- Medicare Advantage (HMO includes A&B)
Part D- Prescription Drug
Qualified Medicare Beneficiary (QMB) Program:
Helps pay premiums, deductibles, coinsurance, and copayments for Part A, Part
B, or both programs
Specified Low-Income Medicare Beneficiary (SLMB) Program:
Helps pay Part B premiums
Qualifying Individual (QI) Program:
Page 2 of 86
,Helps pay Part B premiums
Qualified Disabled Working Individual (QDWI) Program:
Pays the Part A premium for certain disabled and working beneficiaries who
have disabilities
Medicare Part A helps cover what
Inpatient hospital care ● Skilled nursing facility care ● Hospice care ● Home
health care
Medicare Part B helps cover what
Services from doctors and other health care providers ● Outpatient care ● Home
health care ● Durable medical equipment ● Many preventive services
Medicare Part C covers what
includes all benefits and services covered under Part A and Part B and may
include extra benefits and services for an extra cost.
Page 3 of 86
, Medicare part D covers
helps cover the cost of Prescription drugs
Name other types of healthcare coverage
Private insurance coverage (such as group health plan or retiree coverage) ●
TRICARE ● COBRA ● Workers' Compensation ● Liability insurance coverage
Bundled payments
Bundle payments or episode payment models (EPMs) are an alternative means
of payment that encourage organizations to coordinate services to improve the
efficiency of care. Bundled payments are negotiated by CMS and third-party
payors to identify the total allowable expenditures (target price) for a specific
group of services. These payments are predetermined and agreed upon by the
payor and payee. If Medicare and Medicaid billing is acceptable to the
organization, then bundled payment services are already established.
Value based services
Value-based services assist in keeping the cost down. Organizations work to
provide services without exceeding the established cost. If possible, the
organization will attempt to increase its payment by providing less expensive
Page 4 of 86
